Vietnamese nurse has avian flu; retesting reveals missed cases

Mar 7, 2005 (CIDRAP News) – A 26-year-old Vietnamese nurse who helped care for a younger man with H5N1 avian influenza has contracted the illness, but it is unclear whether he acquired it from the patient or from poultry, according to news reports from Vietnam today.

In addition, the World Health Organization (WHO) today confirmed news reports that the H5N1 virus was recently detected in specimens from seven Vietnamese who had tested negative for the virus in January. The agency said it was awaiting more details on the cases, including the outcomes.

The nurse is from Thai Binh province, the scene of four other cases reported in the past 2 weeks, according to news services. He provided "direct treatment" for a 21-year-old Thai Binh man with avian flu at a district healthcare center, according to a Bloomberg News report that quoted Dao Trong Bich, deputy director of the center.

The nurse was admitted to Hanoi's Bach Mai Hospital Feb 28 and is in stable condition, the Associated Press (AP) reported today, quoting an unnamed doctor in the hospital's tropical diseases unit. He tested positive for the virus late last week, the report said.

The nurse is the first healthcare worker known to have contracted the disease. In a report in January, the WHO said, "To date, no H5N1 cases have been detected in health care workers despite several instances of close, unprotected contact with severely ill patients."

But Vietnamese officials said the nurse probably acquired the virus from poultry while visiting his girlfriend in a village where poultry cases were present.

Pham Van Diu, director of the Thai Binh Preventive Medicine Center, said, "He has a girl friend in a village where bird flu is present, and he went to her house and had meals there during Tet," the Lunar New Year celebration in February, according to the Bloomberg report.

An Agence France-Presse (AFP) report quoted Diu as saying, "We don't think it is a human-to-human transmission." He said the commune that the nurse visited had been "heavily hit" by avian flu.

The nurse is one of five Vietnamese confirmed to have avian flu in the past 2 weeks. They include the 21-year-old that the nurse helped care for, a 14-year-old sister of the 21-year-old, and a 35-year-old woman from Hanoi, all of whom are being treated at the Hanoi hospital. In addition, a 69-year-old man from Thai Binh who died Feb 23 had the virus.

The WHO said today it had received official confirmation from Vietnam of the cases in the 21-year-old and his sister, the 35-year-old woman, and the 69-year-old man.

The Chinese news agency Xinhua on Feb 27 had reported a case in a 36-year-old Thai Binh man, but that case was not on the list that the WHO cited as confirmed by Vietnam.

The WHO said specimens from "several" Vietnamese who tested negative for avian flu in January were retested recently in Tokyo. "Retesting detected H5N1 in specimens from seven persons," the agency said. "WHO is awaiting further details about these cases, including outcomes. Upon receipt of this information, WHO will also include these cases in the cumulative total for Vietnam."

The retesting is part of an effort to help Vietnamese health agencies improve their diagnostic tests, the WHO said. Japan's National Institute of Infectious Diseases in Tokyo and the US Centers for Disease Control and Prevention are working with the WHO on the project.

A Feb 24 news story in Nature said the seven samples were among a total of 101 that are being retested in Tokyo. They include 11 from patients who tested positive for avian flu in Vietnam and 90 from patients who were ill but tested negative, according to the report, which quoted Phan Van Tu, head of the microbiology and immunology department at the Pasteur Institute in Ho Chi Minh City.

The Nature story had indicated that only about a third of the 101 samples had been retested up to that point. WHO spokesman Dick Thompson confirmed by e-mail today that about a third of the samples have been retested so far, leaving open the possibility that more missed cases could be found.

The WHO also noted today the retrospective identification of a case of avian flu that occurred in Vietnam in February 2004. The case was in a boy who had fatal encephalitis. It was identified in November 2004 when specimens from the boy were tested in a study of encephalitis. The case was revealed when described in the New England Journal of Medicine in February.

See also:

Mar 7 WHO statement
http://www.who.int/csr/don/2005_03_07/en/

CIDRAP avian flu case-count tables
http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/case-count/avflucount.html

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